Sivagowry Rasalingam Mørk1, Carsten Stengaard2, Louise Linde3, Jacob Eifer Møller3, Lisette Okkels Jensen3, Henrik Schmidt4, Lars Peter Riber5, Jo Bønding Andreasen6, Sisse Anette Thomassen6, Helle Laugesen6, Phillip Michael Freeman7, Steffen Christensen8, Jacob Raben Greisen8, Mariann Tang9, Peter Hasse Møller-Sørensen10, Lene Holmvang11, Emilie Gregers11, Jesper Kjaergaard11, Christian Hassager11, Hans Eiskjær2, Christian Juhl Terkelsen2,12. 1. Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. sivarasa@rm.dk. 2. Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. 3. Department of Cardiology, Odense University Hospital, Odense, Denmark. 4. Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark. 5. Department of Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark. 6. Department of Anaesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark. 7. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. 8. Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark. 9. Department of Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark. 10. Cardiothorascic Anaesthesiology, Copenhagen University Hospital, Copenhagen, Denmark. 11. Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark. 12. The Danish Heart Foundation, Copenhagen, Denmark.
Abstract
BACKGROUND: Mechanical circulatory support (MCS) with either extracorporeal membrane oxygenation or Impella has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). The objective of this study was to describe the gradual implementation, survival and adherence to the national consensus with respect to use of MCS for OHCA in Denmark, and to identify factors associated with outcome. METHODS: This retrospective, observational cohort study included patients receiving MCS for OHCA at all tertiary cardiac arrest centers (n = 4) in Denmark between July 2011 and December 2020. Logistic regression and Kaplan-Meier survival analysis were used to determine association with outcome. Outcome was presented as survival to hospital discharge with good neurological outcome, 30-day survival and predictors of 30-day mortality. RESULTS: A total of 259 patients were included in the study. Thirty-day survival was 26%. Sixty-five (25%) survived to hospital discharge and a good neurological outcome (Glasgow-Pittsburgh Cerebral Performance Categories 1-2) was observed in 94% of these patients. Strict adherence to the national consensus showed a 30-day survival rate of 30% compared with 22% in patients violating one or more criteria. Adding criteria to the national consensus such as signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow < 100 min, pH > 6.8 and lactate < 15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified asystole (RR 1.36, 95% CI 1.18-1.57), pulseless electrical activity (RR 1.20, 95% CI 1.03-1.41), initial pH < 6.8 (RR 1.28, 95% CI 1.12-1.46) and lactate levels > 15 mmol/L (RR 1.16, 95% CI 1.16-1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had reduced risk of 30-day mortality (RR 0.63, 95% CI 0.52-0.76). CONCLUSIONS: A high survival rate with a good neurological outcome was observed in this Danish population of patients treated with MCS for OHCA. Stringent patient selection for MCS may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors.
BACKGROUND: Mechanical circulatory support (MCS) with either extracorporeal membrane oxygenation or Impella has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). The objective of this study was to describe the gradual implementation, survival and adherence to the national consensus with respect to use of MCS for OHCA in Denmark, and to identify factors associated with outcome. METHODS: This retrospective, observational cohort study included patients receiving MCS for OHCA at all tertiary cardiac arrest centers (n = 4) in Denmark between July 2011 and December 2020. Logistic regression and Kaplan-Meier survival analysis were used to determine association with outcome. Outcome was presented as survival to hospital discharge with good neurological outcome, 30-day survival and predictors of 30-day mortality. RESULTS: A total of 259 patients were included in the study. Thirty-day survival was 26%. Sixty-five (25%) survived to hospital discharge and a good neurological outcome (Glasgow-Pittsburgh Cerebral Performance Categories 1-2) was observed in 94% of these patients. Strict adherence to the national consensus showed a 30-day survival rate of 30% compared with 22% in patients violating one or more criteria. Adding criteria to the national consensus such as signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow < 100 min, pH > 6.8 and lactate < 15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified asystole (RR 1.36, 95% CI 1.18-1.57), pulseless electrical activity (RR 1.20, 95% CI 1.03-1.41), initial pH < 6.8 (RR 1.28, 95% CI 1.12-1.46) and lactate levels > 15 mmol/L (RR 1.16, 95% CI 1.16-1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had reduced risk of 30-day mortality (RR 0.63, 95% CI 0.52-0.76). CONCLUSIONS: A high survival rate with a good neurological outcome was observed in this Danish population of patients treated with MCS for OHCA. Stringent patient selection for MCS may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors.
Authors: Mark Dennis; Hergen Buscher; David Gattas; Brian Burns; Karel Habig; Paul Bannon; Sanjay Patel; Heidi Buhr; Claire Reynolds; Sean Scott; Priya Nair; Jon Hayman; Emily Granger; Ryan Lovett; Paul Forrest; Jennifer Coles; David A Lowe Journal: Crit Care Resusc Date: 2020-03 Impact factor: 2.159
Authors: Yang-Chao Zhao; Xi Zhao; Guo-Wei Fu; Ming-Jun Huang; Hui Zhao; Zhen-Qing Wang; Xing-Xing Li; Jun Li Journal: Front Med (Lausanne) Date: 2022-06-13
Authors: Arthur S Slutsky; Alain Combes; Daniel Brodie; Darryl Abrams; Graeme MacLaren; Roberto Lorusso; Susanna Price; Demetris Yannopoulos; Leen Vercaemst; Jan Bělohlávek; Fabio S Taccone; Nadia Aissaoui; Kiran Shekar; A Reshad Garan; Nir Uriel; Joseph E Tonna; Jae Seung Jung; Koji Takeda; Yih-Sharng Chen Journal: Intensive Care Med Date: 2021-09-10 Impact factor: 17.440